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Clinical Prediction Rule of Wisnivesky et al for Placing a Patient with Suspected Pulmonary Tuberculosis into Isolation

Purpose: To determine if a patient with possible pulmonary tuberculosis should be placed in isolation using the prediction rule of Wisnivesky et al.

Description

Wisnivesky et al developed a clinical prediction rule for deciding if an inpatient with possible pulmonary tuberculosis should be placed in respiratory isolation. The authors are from Mount Sinai Medical Center, Cornell University and St Barnabas Hospital in New York City.


Parameters:

(1) risk factors or symptoms for tuberculosis

(2) PPD tuberculin skin test results

(3) shortness of breath

(4) temperature

(5) pulmonary physical examination

(6) chest X-ray

 

Parameter

Finding

Points

risk factors or symptoms of TB

none

0

 

present

4

PPD skin test results

negative

0

 

positive

5

shortness of breath

absent

0

 

present

-3

temperature

< 38.5°C

0

 

38.5 - 39.0°C

3

 

> 39.0°C

6

physical examination

crackles absent

0

 

crackles present

-3

chest X-ray

upper lobes not consolidated

0

 

upper lobes consolidated

6

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum total score: (-6)

• maximum total score: 21

• A score >= 1 was used as the criterion for placing the patient in isolation.

 

Performance:

• The sensitivity was 95% and specificity was 35%.

• The rule had a negative predictive value of almost 100% but a low positive predictive value.


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Specialty

Objective

ICD-10